- offers direct clinical applicability - designed to replicate authentic/functioning environments - direct solutions to practical problems - theory based knowledge

1. Systematic reviews 2. RCT 3. Cohort studies 4. Case studies, case series 5. (Bottom- most bias) clinical experience

Final exam Flashcards by Jena Stewart

Evidence cycle

Ask–acquire–appraise–apply

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Hayward’s evidence cycle

Adds in assess

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Making a health decision takes what into consideration

Patients circumstance, research evidence, clinical expertise, and patients values/preferences

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Background question components

Question + condition

Ex: (what causes) +(Lyme disease)

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Foreground question components

“PICO”

Patient +intervention+ comparison + outcome

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Diagnostic PICO

P: describe the patient
I: new diagnostic test
C: gold standard test
O: condition to be detected

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Prognostic PICO

P: describe patient
I: prognostic factor
C: no prognostic factor
O: health state

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Harm PICO

P: describe the patient
I: exposure
C: lack of exposure
O: health state

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What is EBCP

Recognize problems, asking questions, evaluating and applying evidence

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Clinical research

offers direct clinical applicability
designed to replicate authentic/functioning environments
direct solutions to practical problems
theory based knowledge

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Basic science research

little clinical relevance
performed in controlled lab setting
address theoretical issues

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6 Levels of the hierarchy pyramids

(Lowest-least) in vitro research
Animal research
Case series, case studies, surveys
Cohort studies, case control studies
RCT
Meta analyses, systematic reviews

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Likelihood of bias

Systematic reviews
RCT
Cohort studies
Case studies, case series
(Bottom- most bias) clinical experience

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Case control studies or cohort studies

Start with patients who have the disease
Match them with controls
Retrospective

(+) ethnically challenging diseases, rare conditions, limited resources

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Best study to show causation

RCT

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Meta-analysis or systematic review

Combines the results of many studies

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Sensitivity

Probability of a positive test in someone who has the disease

“PID”

In a 4*4 it’s the top left/ total left column

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Specificity

Probability of a negative test in someone who doesn’t have the disease

“NIH”

In a 4*4 it’s the bottom right/ total right column

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Positive predictive value

Probability that a patient with a positive test really does have the disease

In a 4*4 it’s the top left/ top row

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Negative predictive value

The probability that a patient with a negative test really does not have the disease

In a 4*4 it’s the bottom right/bottom row

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Positive likelihood ratio

ratio (+in disease/ total in disease)/ (+ no disease/ total no disease)

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What are examples of exposures

Survey, file review, interview

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Interpretation of + likelihood ratio

1: test is 5 times more likely in patients w/ disease than without

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Statistical Test to use if:

Describe one group

Normal: mean, SD

Non-normal: median

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Statistical Test to use if: | predict value from another measured variable

normal: simple linear regression or non linear regression | non-normal: non parametric regression

Where do you look for prognostic factors

Table 1

How to detect similar outcome?

Did they use the same method to measure what you are researching

How to find if the follow up sufficiently complete?

Number of starters and follow up with are equal, usually a flow chart Was there enough time to see factors

Risk ratio, odds ratio?

Rr= times | Odds ratio= association

Paired groups vs unpaired groups

Paired- taking data from 1 patient in two instances, grouping two points of data Unpaired- not comparing groups of data

Normal distribution of data matches what

A bell curve

T test

Compares two groups Can be pried or unpaired Gives t value, but look at p value

P value

Significant significance if p

Mann-Whitney

Difference between 2 unpaired groups | Gives u p r values

Wilcoxon test

Paired groups

ANOVA

Compares 3 or more groups | Report f and p value

Pearson test

Test of association

Spearman

Test of association | Use with non normally distributed data

Linear regression

Asses relationship between 2 or more variables to see if there is a prediction

Doe def

Disease oriented evidence

Poem def

Patient oriented evidence that matters

Doe examples

Insight into patient physiology Of interest to health provider BP, reflexes, nervoscope

Poem examples

Self reported by patient Of interest to patient and clinician Pain rating, level of function, quality of life

Outcome measure examples

Pain, mental status, disability measurement tool, energy, etc

What type of question do you use to find outcome measure

Background question

Clinimetric properties

Reliability, validity, sensitivity to change, and internal consistency Don't try to make up your own outcome measure

Outcome measure for pain

Quadruple vas | NRS

Outcome measure for spine

``` Oswesty Bourne neck questionnaire Neck disability index Roland Morris scale Headache disability index ```

Outcome measure for general health

Health status questionnaire

Outcome measure for upper extremity

Upper extremity functional index

Outcome measure for lower extremity

Foot ankle outcome score Hip dysfunction and osteoarthritis outcome score Knee and osteoarthritis outcome score Lower extremity functional scale

Outcomes for general extremity

Rheumatoid and arthritis outcome score

VAS

10 cm line | Please make a vertical line where your pain is at

Vertical VAS works best for who

Elderly

NRS

Scale 1-10

Quadruple VAS

Pain right now? Typical or average pain? Pain at its best? Pain at its worst?

Pain diagrams

Body and you color in where the pain is

ODI

``` 10 sections of daily activity 6 choices in each Scored 0-5 Add each section for overall disability Multiply by 2 for % ```

NDI

Neck disability | Modified ODI by Howard Vernon

RMQ

Low back disability | 24 statements

Bournemouth

7 items Each on scale of 10 Take total points and divide by 70%

Headache disability index

2 subscales | Emotional and functional

UEFI or LEFI

20 items Scored 0-4 Total score /80 x 100=% Score gets higher with lower pain

Foot and ankle, hip dysfunction, knee, RA

6 areas- symptoms, stiffness, pain, ADL, sports/recreation, quality of life Scored 0-4 Total score /168 x 100=% Needs a change of 10% for meaningful improvement

General Health Status Questionnaire

8 sub-scales of general health 2 summary measures overall score 3 individual diagnostic questions

8 sub-scales of general health

physical functioning, role physical, body pain, general health, vitality, social functioning, role emotional, mental health

2 summary measures

Physical health and emotional health

Final exam Flashcards

(67 cards)